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Blasco PM, Acar S, Guy SM, Saxton SN, Duvall S, Atkins KL, Markwardt S. Executive function and preterm birth: A longitudinal study. Early Hum Dev 2024; 192:105996. [PMID: 38663108 DOI: 10.1016/j.earlhumdev.2024.105996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 05/04/2024]
Abstract
Infants born low birth weight (LBW) and preterm are at risk for developmental delay and cognitive deficits. These deficits can lead to lifelong learning difficulties and high-risk behaviors. Preterm (PT) and full-term (FT) groups were compared across infant and toddler measures of behavior and development to extract early indicators of executive function (EF). The goal was to extract indicators of EF from standardized infant assessments. PT (<2500 grams and <37 weeks) and FT (> 2500 grams and >37 weeks) were compared across assessment and EF components were identified from the BSID-III. A multivariate linear model was used to examine group differences. All children (99 PT and 46 FT) were administered the Bayley III and the DMQ assessments for session 1 (6-8 months). During session 2, N=78 PT and 37 FT (18-20 months), the CBCL was added to previous assessments, and the BRIEF-P was added to previous assessments in session 3, N= 52 PT and 36 FT for session 3 (See Table 1). Significant change scores were found on BSID-III subtests and EF components across all 3 sessions. The PT group also showed significantly more behavioral concerns on the CBCL at 18 months and 36 months and had lower scores on the BRIEF-P than their FT peers. The number of children born PT (N = 27, 52%) who were in Early Intervention (EI) increased across the 3 sessions. Examining early indicators of EFs supported the development of early identification that could lead to decrease adverse outcomes often associated with preterm birth.
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Affiliation(s)
| | - Serra Acar
- University of Massachusetts Boston, MA, United States of America
| | - Sybille M Guy
- Western Oregon University, OR, United States of America
| | - Sage N Saxton
- Oregon Health & Science University, OR, United States of America
| | - Susanne Duvall
- Oregon Health & Science University, OR, United States of America
| | - Kristi L Atkins
- Oregon Health & Science University, OR, United States of America
| | - Sheila Markwardt
- Oregon Health & Science University, OR, United States of America
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Duvall SW, Greene RK, Phelps R, Rutter TM, Markwardt S, Grieser Painter J, Cordova M, Calame B, Doyle O, Nigg JT, Fombonne E, Fair D. Factors Associated with Confirmed and Unconfirmed Autism Spectrum Disorder Diagnosis in Children Volunteering for Research. J Autism Dev Disord 2024:10.1007/s10803-024-06329-y. [PMID: 38607474 DOI: 10.1007/s10803-024-06329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Diagnostic accuracy of autism spectrum disorder (ASD) is crucial to track and characterize ASD, as well as to guide appropriate interventions at the individual level. However, under-diagnosis, over-diagnosis, and misdiagnosis of ASD are still prevalent. METHODS We describe 232 children (MAge = 10.71 years; 19% female) with community-based diagnoses of ASD referred for research participation. Extensive assessment procedures were employed to confirm ASD diagnosis before study inclusion. The sample was subsequently divided into two groups with either confirmed ASD diagnoses (ASD+) or unconfirmed/inaccurate diagnoses (ASD-). Clinical characteristics differentiating the groups were further analyzed. RESULTS 47% of children with community-based ASD diagnoses did not meet ASD criteria by expert consensus. ASD + and ASD- groups did not differ in age, gender, ethnicity, or racial make-up. The ASD + group was more likely to have a history of early language delays compared to the ASD- group; however, no group differences in current functional language use were reported by caregivers. The ASD + group scored significantly higher on ADI-R scores and on the ADOS-2 algorithm composite scores and calibrated severity scores (CSSs). The ASD- group attained higher estimated IQ scores and higher rates of psychiatric disorders, including anxiety disorder, disruptive behavior, and mood disorder diagnoses. Broadly, caregiver questionnaires (SRS-2, CCC-2) did not differentiate groups. CONCLUSION Increased reported psychiatric disorders in the ASD- group suggests psychiatric complexity may contribute to community misdiagnosis and possible overdiagnosis of ASD. Clinician-mediated tools (ADI-R, ADOS-2) differentiated ASD + versus ASD- groups, whereas caregiver-reported questionnaires did not.
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Affiliation(s)
- Susanne W Duvall
- Departments of Pediatrics and Psychiatry, Institute on Development and Disability, Center for Development and Child Rehabilitation, Oregon Health & Science University, 707 SW Gaines St, Portland, OR, 98239, USA.
| | - Rachel K Greene
- Departments of Pediatrics, Institute on Development and Disability, Center for Development and Child Rehabilitation, Oregon Health & Science University, 707 SW Gaines St, Portland, OR, USA
| | - Randi Phelps
- Staff Psychologist in the Division of Psychology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA
- Department of Child Health, University of Arizona College of Medicine, 475 N 5th St, Phoenix, AZ, USA
| | - Tara M Rutter
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Rd, Portland, OR, USA
| | - Sheila Markwardt
- Biostatistician III, Biostatistics and Design Program, Oregon Health & Science University, 3181 SW Sam Jackson Rd, Portland, OR, 97217, USA
| | - Julia Grieser Painter
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Rd, Portland, OR, USA
| | - Michaela Cordova
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA, USA
| | - Beth Calame
- Department of Psychiatry, School of Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Rd, Portland, OR, USA
| | - Olivia Doyle
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Rd, Portland, OR, 97217, USA
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Rd, Portland, OR, 97239, USA
| | - Eric Fombonne
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Rd, Portland, OR, 97239, USA
| | - Damien Fair
- College of Education and Human Development, Department of Pediatrics, Medical School University of Minnesota, Masonic Institute for the Developing Brain, Professor, Institute of Child Development, 2025 E. River Parkway 7962A, Minneapolis, MN, 55414, USA
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Karamooz E, Brixey AG, Rydzak CE, Primack SL, Markwardt S, Barker AF. Prevalence of pulmonary artery dilation in non-cystic fibrosis bronchiectasis: a computed tomography analysis from a cohort of the US Bronchiectasis and Nontuberculous Mycobacteria Research Registry. J Thorac Dis 2024; 16:1496-1502. [PMID: 38505050 PMCID: PMC10944741 DOI: 10.21037/jtd-23-1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/05/2024] [Indexed: 03/21/2024]
Abstract
Although pulmonary artery (PA) dilation is independently associated with significant morbidity and mortality in patients with pulmonary diseases irrespective of diagnosed pulmonary hypertension, its relationship with nontuberculous mycobacteria (NTM) is unknown. The Bronchiectasis and NTM Research Registry is a multicenter registry created to foster research in non-cystic fibrosis (CF) bronchiectasis and NTM lung disease. The majority of patients with non-CF bronchiectasis at Oregon Health & Science University have NTM infections. To determine the prevalence of PA dilation in these patients and its association with supplemental oxygen use, severity of bronchiectasis, tobacco use, and NTM in the sputum culture, we evaluated the chest computed tomography (CT) scans from 321 patients in a cross-sectional analysis. We measured the severity of bronchiectasis by applying modified Reiff criteria and measured the diameters of the PA and aorta (Ao), with PA dilation defined as a PA:Ao ratio >0.9. In our cohort, the mean age was 67.3 years and 83.2% were female. The mean modified Reiff score was 7.1, indicating moderate disease severity. Forty-two patients (13.1%) were found to have PA dilation. PA dilation was positively associated with the use of supplemental oxygen (P<0.001), but there was no association between PA dilation and NTM infection.
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Affiliation(s)
- Elham Karamooz
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Anupama G. Brixey
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Chara E. Rydzak
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Steven L. Primack
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Sheila Markwardt
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alan F. Barker
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Karamooz E, Brixey AG, Rydzak CE, Primack SL, Markwardt S, Barker AF. Prevalence of pulmonary artery dilation in non-cystic fibrosis bronchiectasis: A CT analysis from a cohort of the US Bronchiectasis and Nontuberculous Mycobacteria Research Registry. Res Sq 2023:rs.3.rs-2711488. [PMID: 36993456 PMCID: PMC10055630 DOI: 10.21203/rs.3.rs-2711488/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Although pulmonary artery (PA) dilation is independently associated with significant morbidity and mortality in patients with pulmonary diseases irrespective of diagnosed pulmonary hypertension, its relationship to nontuberculous mycobacteria (NTM) is unknown. To determine the prevalence of PA dilation in patients with NTM-predominant non-CF bronchiectasis, we evaluated the chest computed tomography (CT) scans from 321 patient in the United States based Bronchiectasis and NTM Research Registry. The majority of our cohort had NTM infection. We measured the severity of bronchiectasis using modified Reiff criteria and measured the diameters of the PA and aorta (Ao), with PA dilation defined as a PA:Ao ratio > 0.9. Forty-two patients (13%) were found to have PA dilation. PA dilation was positively associated with the use of supplemental oxygen (p < 0.001), but there was no association between PA dilation and NTM infection.
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Affiliation(s)
- Elham Karamooz
- Oregon Health & Science University Pulmonary & Critical Care
| | - Anupama G Brixey
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Chara E Rydzak
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Steven L Primack
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Sheila Markwardt
- Oregon Health & Science University-Portland State University School of Public Health
| | - Alan F Barker
- Oregon Health & Science University Pulmonary & Critical Care
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Barton JL, Markwardt S, Niederhausen M, Schue A, Dougherty J, Katz P, Saha S, Yelin EH. Are We on the Same Page? A Cross-Sectional Study of Patient-Clinician Goal Concordance in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:625-633. [PMID: 34569172 PMCID: PMC8957637 DOI: 10.1002/acr.24794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient-clinician goal concordance is associated with improved outcomes in certain chronic diseases but not explored in rheumatoid arthritis (RA). We examined goal concordance, correlates of concordance, and the association of concordance with health outcomes. METHODS Adult patients with RA seen at least 1 time in the prior 12 months at 1 of 2 rheumatology clinics participated. Patients and their clinicians independently ranked top 3 goals for RA treatment from 8 options before a routine visit. Patients completed postvisit surveys on health, demographic information, health literacy, and adherence. Goal concordance was defined as the patient's number 1 goal being among the clinician's top 3 goals for that patient. Bivariable and multivariable logistic regression models were used to examine correlates of concordance. RESULTS Patients were 58% female and 16% Spanish-speaking, and 29% had limited health literacy. Among 204 patient-clinician dyads, 20% were goal-discordant. "Have less pain" was selected by both patient and clinician in 81% of dyads, followed by "have fewer problems doing daily activities" by 63%. Otherwise, clinicians prioritized avoiding side effects, whereas patients ranked improved sleep, fatigue, and mood. Longer disease duration was associated with discordance (median 13.3 years, interquartile range [IQR] 5.2-20 among discordant vs. 7 years, IQR 4-14; P = 0.039); higher depressive symptoms were associated with concordance (8.1% vs. 24%; P = 0.04). Goal concordance was associated with higher medication adherence (adjusted odds ratio 2.76 [95% confidence interval 1.01, 7.56]). CONCLUSION One in 5 patient-clinician dyads had discordant treatment goals. Goal concordance was associated with higher medication adherence. Studies to improve goal elicitation and communication of patients with RA's priorities are needed.
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Affiliation(s)
- Jennifer L. Barton
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
| | | | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
| | - Allison Schue
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
| | - Jacob Dougherty
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
| | - Patricia Katz
- University of California, San Francisco, San Francisco, CA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
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Botoseneanu A, Markwardt S, Quiñones AR. Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study. Gerontology 2023; 69:826-838. [PMID: 36858034 PMCID: PMC10442862 DOI: 10.1159/000528648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 12/07/2022] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear. METHODS Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58% female, 25% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score. RESULTS Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95% CI = 1.01-1.20), diabetes (IRR = 1.19, 95% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95% CI = 1.02-1.11), hypertension (IRR = 1.06, 95% CI = 1.02-1.11), heart disease (IRR = 1.06, 95% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men. CONCLUSION The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Ana R. Quiñones
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Kumar K, Markwardt S, Morris CC, Herman T, Chau T, Samhan A, Lantz G, Chadderdon SM, Song HK, Zahr FE, Golwala H. INTERMEDIATE TERM OUTCOMES FOLLOWING TAVR IN PATIENTS WITH CHRONIC KIDNEY DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Quiñones A, Markwardt S, Bobo M, Allore H, Newsom J, Nagel C, Botoseneanu A, Dorr D. MULTIMORBIDITY PROGRESSION AMONG MEDICARE BENEFICIARIES IN THE HEALTH AND RETIREMENT STUDY (1991–2015). Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Older adults are at greater risk for developing and accumulating multimorbidity (2+ chronic conditions). This study describes the characteristics of older adults with multimorbidity using Medicare claims over a 24-year period. The HRS-Medicare data (1991-2015, N=17,199, age 67+ years) were used in descriptive analyses. We identified 8,800 (51%) beneficiaries who did not have multimorbidity at first observation (no multimorbidity), 6,270 (36%) with 2-4 conditions at the first observation (low multimorbidity), and 2,129 (12%) with 5+ conditions at the first observation (high multimorbidity). Older respondents (80+ years) had lower levels of multimorbidity at baseline compared with younger respondents (< 70 years); this appeared to be related to differences by birth cohort. Higher proportions of minoritized groups had high multimorbidity (15% non-Hispanic Black; 20% Hispanic; 11% non-Hispanic White). Despite only being 22% of the entire sample, persons with obese body mass index (>30) represented 41% of the high multimorbidity group. Higher incidence rates of disease accumulation were noted for Black (89/1,000 person years [py]) and Hispanic (94/1,000 py) compared with White respondents (82/1,000 py) in the high multimorbidity group. Hospitalization and ED rates increased linearly between the low and high multimorbidity groups. Functional loss was more prevalent in the high multimorbidity group compared with the no multimorbidity group; no difference was observed between no and low multimorbidity. Results highlight sociodemographic differences between Medicare fee-for-service beneficiaries with differing levels of multimorbidity, allowing new insights to guide interventions that address burdensome changes in late life.
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Affiliation(s)
- Ana Quiñones
- Oregon Health and Science University , Portland, Oregon , United States
| | - Sheila Markwardt
- Oregon Health & Science University , Portland, Oregon , United States
| | - Michelle Bobo
- Oregon Health & Science University , Portland, Oregon , United States
| | | | - Jason Newsom
- Portland State University , Portland, Oregon , United States
| | - Corey Nagel
- University of Arkansas for Medical Sciences , Little Rock, Arkansas , United States
| | - Anda Botoseneanu
- University of Michigan Dearborn , Dearborn, Michigan , United States
| | - David Dorr
- Oregon Health & Science University , Portland, Oregon , United States
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Klein TA, Hartung D, Markwardt S. The impact of CARA mandates on nurse practitioner controlled substance prescribing in Oregon: a cohort study. Subst Abuse Treat Prev Policy 2022; 17:5. [PMID: 35101077 PMCID: PMC8805433 DOI: 10.1186/s13011-022-00431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background In 2017, the United States Comprehensive Addiction and Recovery Act (CARA) expanded authorization to prescribe buprenorphine for opioid use disorder (OUD) to nurse practitioners (NPs). Compared to physicians, NPs were required to complete 16 additional hours of training on controlled substance prescribing before a buprenorphine waiver application. As this differential additional education mandate was seen as a potential barrier, we evaluated the impact of this requirement on both NP waiver acquisition and prescribing of controlled substances, comparing NPs who obtained waivers to those who had not. Methods Through 2016–2018 Oregon Prescription Drug Monitoring Program and linked NP licensure data, we identified factors associated with waiver acquisition at baseline (2016) and evaluated changes in controlled substance prescribing before (2016) and after waiver acquisition (2018). Using chi-square and Mann-Whitney U testing, we calculated and described controlled substance prescribing types, rates, and patient level quantities including co-prescribing of benzodiazepines and opioids by NPs. Multivariable linear regression compared prescribing by waivered and non-waivered NPs for significant changes in non-buprenorphine controlled substance prescribing. Results Waivered NPs were more likely to have a psychiatric certification, have prior disciplinary action, and have generally higher levels of non-buprenorphine controlled substance prescribing than their non-waivered counterparts. While there was a significant increase in opioid prescriptions per patient among waivered NPs, following CARA implementation, co-prescribing of benzodiazepines and opioids significantly declined among waivered NPs relative to non-waivered NPs. Conclusions Although educational requirements were rescinded in 2021 for most applicants, enhanced opioid prescribing training should be incorporated into professional educational offerings regardless of regulatory mandate. We recommended continued focus on education regarding avoidance of high risk prescribing such as co-prescribing of opioids and benzodiazepines. NPs who acquire waivers may take on higher risk patients already using opioids, and these findings may represent transitions in practice and patient setting.
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Hartung DM, Markwardt S, Johnston K, Geddes J, Baker R, Leichtling G, Hildebran C, Chan B, Cook RR, McCarty D, Ghitza U, Korthuis PT. Association between treatment setting and outcomes among oregon medicaid patients with opioid use disorder: a retrospective cohort study. Addict Sci Clin Pract 2022; 17:45. [PMID: 35986384 PMCID: PMC9389731 DOI: 10.1186/s13722-022-00318-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Residential treatment is a common approach for treating opioid use disorder (OUD), however, few studies have directly compared it to outpatient treatment. The objective of this study was to compare OUD outcomes among individuals receiving residential and outpatient treatment. METHODS A retrospective cohort study used linked data from a state Medicaid program, vital statistics, and the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episodes Dataset (TEDS) to compare OUD-related health outcomes among individuals treated in a residential or outpatient setting between 2014 and 2017. Multivariable Cox proportional hazards and logistic regression models examined the association between treatment setting and outcomes (i.e., opioid overdose, non-overdose opioid-related and all-cause emergency department (ED) visits, hospital admissions, and treatment retention) controlling for patient characteristics, co-morbidities, and use of medications for opioid use disorders (MOUD). Interaction models evaluated how MOUD use modified associations between treatment setting and outcomes. RESULTS Of 3293 individuals treated for OUD, 957 (29%) received treatment in a residential facility. MOUD use was higher among those treated as an outpatient (43%) compared to residential (19%). The risk of opioid overdose (aHR 1.39; 95% CI 0.73-2.64) or an opioid-related emergency department encounter or admission (aHR 1.02; 95% CI 0.80-1.29) did not differ between treatment settings. Independent of setting, MOUD use was associated with a significant reduction in overdose risk (aHR 0.45; 95% CI 0.23-0.89). Residential care was associated with greater odds of retention at 6-months (aOR 1.71; 95% CI 1.32-2.21) but not 1-year. Residential treatment was only associated with improved retention for individuals not receiving MOUD (6-month aOR 2.05; 95% CI 1.56-2.71) with no benefit observed in those who received MOUD (aOR 0.75; 95% CI 0.46-1.29; interaction p = 0.001). CONCLUSIONS Relative to outpatient treatment, residential treatment was not associated with reductions in opioid overdose or opioid-related ED encounters/hospitalizations. Regardless of setting, MOUD use was associated with a significant reduction in opioid overdose risk.
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Affiliation(s)
- Daniel M Hartung
- Oregon State University College of Pharmacy, Portland, OR, USA.
- College of Pharmacy, Oregon State University @ Oregon Health & Science University, Robertson Collaborative Life Sciences Building (RLSB), 2730 S Moody Ave., CL5CP, Portland, OR, 97201-5042, USA.
| | - Sheila Markwardt
- Oregon Health & Science University, Biostatistics and Design Program, Portland, OR, USA
| | - Kirbee Johnston
- Oregon State University College of Pharmacy, Portland, OR, USA
| | - Jonah Geddes
- PSU-OHSU School of Public Health, Portland, OR, USA
| | - Robin Baker
- PSU-OHSU School of Public Health, Portland, OR, USA
| | | | | | - Brian Chan
- Oregon Health & Science University, Section of Addiction Medicine, Portland, OR, USA
| | - Ryan R Cook
- Oregon Health & Science University, Section of Addiction Medicine, Portland, OR, USA
| | | | - Udi Ghitza
- National Institute On Drug Abuse (NIDA), Center for the Clinical Trials Network (CCTN), Bethesda, ML, USA
| | - P Todd Korthuis
- PSU-OHSU School of Public Health, Portland, OR, USA
- Oregon Health & Science University, Section of Addiction Medicine, Portland, OR, USA
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Kopstick AJ, Rufener CR, Banerji AO, Hudkins MR, Kirby AL, Markwardt S, Orwoll BE. Recognizing Pediatric ARDS: Provider Use of the PALICC Recommendations in a Tertiary Pediatric ICU. Respir Care 2022; 67:985-994. [PMID: 35728822 PMCID: PMC9994144 DOI: 10.4187/respcare.09806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND For almost 50 years, pediatricians used adult guidelines to diagnose ARDS. In 2015, specific criteria for pediatric ARDS were defined. However, it remains unclear how frequently providers recognize pediatric ARDS and whether recognition affects adherence to consensus recommendations. METHODS This was a mixed-method, retrospective study of mechanically ventilated pediatric subjects after the release of the pediatric ARDS recommendation statement. Pediatric ARDS cases were identified according to the new criteria. Provider recognition was defined by documentation in the medical record. Pediatric ARDS subjects with and without provider recognition were compared quantitatively according to clinical characteristics, adherence to lung-protective ventilation (LPV), adjunctive therapies, and outcomes. A qualitative document analysis (QDA) was performed to evaluate knowledge and beliefs surrounding the Pediatric Acute Lung Injury Consensus Conference recommendations. RESULTS Of 1,983 subject encounters, pediatric ARDS was identified in 321 (16%). Provider recognition was present in 97 (30%) cases and occurred more often in subjects who were older, had worse oxygenation deficits, or were bone marrow transplant recipients. Recognition rates increased each studied year. LPV practices did not differ based on provider recognition; however, subjects who received it were more likely to experience permissive hypoxemia and adherence to extrapulmonary recommendations. Ultimately, there was no differences in outcomes between the provider recognition and non-provider recognition groups. Three themes emerged from the QDA: (1) pediatric ARDS presents within a complex, multidimensional context, with potentially competing organ system failures; (2) similar to historical conceptualizations, pediatric ARDS was often considered a visual diagnosis, with measures of oxygenation unreferenced; and (3) emphasis was placed on non-evidence-based interventions, such as pulmonary clearance techniques, rather than on consensus recommendations. CONCLUSIONS Among mechanically ventilated children, pediatric ARDS was common but recognized in a minority of cases. Potential opportunities, such as an opt-out approach to LPV, may exist for improved dissemination and implementation of recommended best practices.
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Affiliation(s)
- Avi J Kopstick
- Division of Pediatric Critical Care Medicine, Texas Tech University Health Science Center, El Paso, Texas.
| | - Christina R Rufener
- Division of Pediatric Critical Care Medicine, University of California, San Diego, California
| | - Adrian O Banerji
- Division of General Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Matthew R Hudkins
- Division of Pediatric Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
| | - Aileen L Kirby
- Division of Pediatric Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
| | - Sheila Markwardt
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon
| | - Benjamin E Orwoll
- Division of Pediatric Critical Care Medicine, and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
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Botoseneanu A, Markwardt S, Nagel CL, Allore HG, Newsom JT, Dorr DA, Quiñones AR. Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race/Ethnicity and Body Mass Index. J Gerontol A Biol Sci Med Sci 2022; 77:e89-e97. [PMID: 33880490 PMCID: PMC8824553 DOI: 10.1093/gerona/glab116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups. METHOD We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (≥2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases. RESULTS Overweight and obesity were more prevalent in non-Hispanic Black (82.3%) and Hispanic (78.9%) than non-Hispanic White (70.9 %) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants. CONCLUSIONS Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, USA
- Address correspondence to: Anda Botoseneanu, MD, PhD, University of Michigan, 19000 Hubbard Drive, Dearborn, MI 48126. E-mail:
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, USA
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Heather G Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut,USA
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Jason T Newsom
- Department of Psychology, Portland State University, Oregon, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, USA
| | - Ana R Quiñones
- School of Public Health, Oregon Health & Science University, Portland, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, USA
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13
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Denning E, O'Neill A, Markwardt S, Botoseneanu A, Allore H, Nagel C, Dorr D, Quiñones A. Social Support and Social Strain as Predictors of Depressive Symptom Trajectories Following a Marital Transition. Innov Aging 2021. [PMCID: PMC8682569 DOI: 10.1093/geroni/igab046.3637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
We investigated trajectories of depressive symptoms over 10 years following a marital transition (widowed or divorced) using data from the Health and Retirement Study (N = 377, mean age = 67.55 years; years 2006-2016). Piecewise growth curve models were estimated to investigate whether social support and strain from one’s spouse, measured prior to transition, predicted depressive symptom trajectories following the transition. Covariates included sex, age, education, race/ethnicity, wealth, and chronic conditions. Overall, trajectories of depressive symptoms after a marital transition were significantly negative, indicating a decrease in depressive symptoms over time. Findings did not differ significantly between participants who were widowed and those who were divorced. Spousal social support was associated with an increase in depressive symptoms and spousal social strain was associated with a decrease in depressive symptoms following a marital transition in separate models: support: b = .250, SE = .062, p <.001; strain: b = -.209, SE = .095, p <.05. However, social strain was not significant when examined jointly with social support. Depressive symptoms declined significantly for low (b = -.370, SE = .100, p <.001) and average levels of social support (b = -.113, SE = .037, p <.01), but not for high levels of spouse social support (b = .143, SE = .109, p = .188). These results suggest those with the highest levels of spousal support prior to the transition, whether divorced or widowed, experienced a more difficult recovery and may be targets for additional mental health support following a marital transition.
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Affiliation(s)
- Emily Denning
- Portland State University, Portland, Oregon, United States
| | | | - Sheila Markwardt
- Oregon Health & Science University, Portland, Oregon, United States
| | - Anda Botoseneanu
- University of Michigan - Dearborn, Dearborn, Michigan, United States
| | - Heather Allore
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Corey Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - David Dorr
- Oregon Health & Science University, Portland, Oregon, United States
| | - Ana Quiñones
- Oregon Health & Science University, Portland, Oregon, United States
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14
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Quiñones A, Markwardt S, Allore H, Newsom J, Nagel C, Dorr D, Botoseneanu A. Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014). Innov Aging 2021. [PMCID: PMC8681060 DOI: 10.1093/geroni/igab046.2347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1% in youngest age category [67-69] vs. 50.3% for incident and 66.7% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6% CIND/dementia vs. 15.4% for incident and 16.8% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4%) than in the incident (11.8%) and no multimorbidity groups (13.4%). Non-Hispanic White beneficiaries were more represented in the incident (83.5%) than the prevalent (77.2%) and the no multimorbidity (77.7%). Hispanic beneficiaries were more represented in the no (8.9%) than the prevalent (7.4%) and incident multimorbidity groups (4.7%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.
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Affiliation(s)
- Ana Quiñones
- Oregon Health & Science University, Portland, Oregon, United States
| | - Sheila Markwardt
- Oregon Health & Science University, Portland, Oregon, United States
| | - Heather Allore
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Jason Newsom
- Portland State University, Portland, Oregon, United States
| | - Corey Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - David Dorr
- Oregon Health & Science University, Portland, Oregon, United States
| | - Anda Botoseneanu
- University of Michigan - Dearborn, Dearborn, Michigan, United States
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15
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Ukhanova M, Markwardt S, Furuno J, Davis L, Noble B, Quiñones A. Sex Differences in Potentially Inappropriate Prescribing Among Older Adults With Multimorbidity. Innov Aging 2021. [PMCID: PMC8680312 DOI: 10.1093/geroni/igab046.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns are not well understood. This study sought to identify sex specific risk of PIMs in older adults with cardiovascular-metabolic patterns. Secondary analysis of the Health and Retirement Study interview data (2004-2014; n=6,341, ≥65 y/o) linked to Medicare claims data was conducted. Four multimorbidity patterns were identified based on the list of 20 chronic conditions and included: ‘cardiovascular-metabolic only’, ‘cardiovascular-metabolic plus other physical conditions’, ‘cardiovascular-metabolic plus mental conditions’, and ‘no cardiovascular-metabolic disease’ patterns. Presence of PIM prescribing was identified using the 2015 American Geriatrics Society Beers Criteria, limited to the list of medications to avoid in older adults. Chi-square tests and logistic regressions were used to identify sex differences in prescribing PIMs across multimorbidity patterns: (1) for PIMs overall and (2) for each PIM drug class. Results indicate that on average women were prescribed PIMs more often than men (39.4% and 32.8%, respectively). Women with cardiovascular-metabolic plus other physical patterns (Adj.OR=1.25, 95% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj.OR=1.25, 95% CI: 1.06-1.48) had higher odds of PIM compared to men, however, there were no sex differences in PIM prescribing in the cardiovascular-metabolic only patterns (Adj.OR=1.13, 95% CI: 0.79-1.62). There was variation by sex across different PIM drug classes. Our study emphasizes the need to further reduce PIM prescribing among older adults, and identifies target populations for potential interventions to improve medication prescribing practices.
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Affiliation(s)
- Maria Ukhanova
- Oregon Health & Science University, Portland, Oregon, United States
| | - Sheila Markwardt
- Oregon Health & Science University, Portland, Oregon, United States
| | - Jon Furuno
- Oregon Health & Science University, Portland, Oregon, United States
| | - Laura Davis
- Neighborhood Health Center, Hillsboro, Oregon, United States
| | - Brie Noble
- Oregon Health & Science University, Portland, Oregon, United States
| | - Ana Quiñones
- Oregon Health & Science University, Portland, Oregon, United States
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16
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Ukhanova M, Markwardt S, Furuno JP, Davis L, Noble BN, Quiñones AR. Are there sex differences in potentially inappropriate prescribing in adults with multimorbidity? J Am Geriatr Soc 2021; 69:2163-2175. [PMID: 33959939 DOI: 10.1111/jgs.17194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Limited knowledge exists regarding sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns. This study sought to determine sex differences in PIM prescribing in older adults with cardiovascular-metabolic patterns. DESIGN Retrospective cohort study. SETTING Health and Retirement Study (HRS) 2004-2014 interview data, linked to HRS-Medicare claims data annualized for 2005-2014. STUDY SAMPLE Six thousand three-hundred and forty-one HRS participants aged 65 and older with two and more chronic conditions. MEASUREMENTS PIM events were calculated using 2015 American Geriatrics Society Beers Criteria. Multimorbidity patterns included: "cardiovascular-metabolic only," "cardiovascular-metabolic plus other physical conditions," "cardiovascular-metabolic plus mental conditions," and "no cardiovascular-metabolic disease" patterns. Logistic regression models were used to determine the association between PIM and sex, including interaction between sex and multimorbidity categories in the model, for PIM overall and for each PIM drug class. RESULTS Women were prescribed PIMs more often than men (39.4% vs 32.8%). Overall, women had increased odds of PIM (Adj. odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.16-1.46). Women had higher odds of PIM than men with cardiovascular-metabolic plus physical patterns (Adj. OR = 1.25, 95% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj. OR = 1.25, 95% CI: 1.06-1.48), and there were no sex differences in adults with a cardiovascular-metabolic only patterns (Adj. OR = 1.13, 95% CI: 0.79-1.62). Women had greater odds of being prescribed the following PIMs: anticholinergics, antidepressants, antispasmodics, benzodiazepines, skeletal muscle relaxants, and had lower odds of being prescribed pain drugs and sulfonylureas compared with men. CONCLUSION This study evaluated sex differences in PIM prescribing among adults with complex cardiovascular-metabolic multimorbidity patterns. The effect of sex varied across multimorbidity patterns and by different PIM drug classes. This study identified important opportunities for future interventions to improve medication prescribing among older adults at risk for PIM.
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Affiliation(s)
- Maria Ukhanova
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Jon P Furuno
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA
| | - Laura Davis
- Neighborhood Health Center, Hillsboro, Oregon, USA
| | - Brie N Noble
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
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17
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Muirhead CA, Lanocha N, Markwardt S, MacDonald KD. Evaluation of rescue oral glucocorticoid therapy during inpatient cystic fibrosis exacerbations. Pediatr Pulmonol 2021; 56:891-900. [PMID: 33289316 DOI: 10.1002/ppul.25204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 11/07/2022]
Abstract
An acute pulmonary exacerbation (APE) in cystic fibrosis (CF) is characterized by increased pulmonary symptoms attributed to bacterial colonization, neutrophil recruitment, and inflammation. Antimicrobials, airway clearance, and nutrition are the mainstay of therapy. However, when patients fail to improve, corticosteroids have been added to therapy. We retrospectively examined the use of rescue steroids in a children's hospital from 2013 to 2017 during CF APE treatment following at least 1 week of inpatient therapy without expected clinical improvement. In total, 106 encounters of 53 unique patients, aged 6-20 years, who had FEV1 percent predicted (FEV1pp) data at baseline, admission, midpoint, and discharge, and had admission duration of at least 12 days were studied. Encounters treated with steroids had less improvement at midpoint percent change from admission in FEV1pp (4.9 ± 11.3) than nonsteroid group change in FEV1pp (20.1 ± 24.6; p < .001). Failure to improve as expected was the rationale for steroid use. At discharge, there was no difference in mean FEV1pp (p = .76). Delays in steroid therapy by waiting until the end of the second week increased the total length of stay (LOS). Propensity matching, comparing outcomes in patients without midpoint improvement in FEV1pp, was also evaluated. There was no difference in admission or discharge FEV1pp between groups. Equally, no difference in FEV1pp at follow-up visit or in time until the next APE was detected. Secondary analysis for associations including gender, genotype, fungal colonization, or inhaled antimicrobials was nonsignificant. These data suggest rescue use of corticosteroids during APE does not predictably impact important outcome measures during CF APE treatment.
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Affiliation(s)
- Corinne A Muirhead
- Department of Pharmacy, Oregon Health and Science University, Portland, Oregon, USA
| | - Natalie Lanocha
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Sheila Markwardt
- Department of Biostatistics, Oregon Health and Science University, Portland, Oregon, USA
| | - Kelvin D MacDonald
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
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Abstract
BACKGROUND Our understanding of how multimorbidity progresses and changes is nascent. OBJECTIVES Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297). MEASURES Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms. RESULTS Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014. CONCLUSIONS AND RELEVANCE Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.
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Affiliation(s)
- Ana R. Quiñones
- Department of Family Medicine, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, OR
| | - Miriam R. Elman
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Sheila Markwardt
- OHSU-PSU School of Public Health, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI
- Institute of Gerontology, University of Michigan, Ann Arbor, MI
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Botoseneanu A, Markwardt S, Quinones A. Metabolic and Inflammatory Biomarkers, Multimorbidity Combinations and Disability Burden Among Older Americans. Innov Aging 2020. [PMCID: PMC7740212 DOI: 10.1093/geroni/igaa057.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Specific multimorbidity combinations, in particular those including arthritis, stroke, or cognitive impairment have been associated with high burden of ADL/IADL disability. However, the biologic underpinnings of these associations are still unclear. We used data from the Health & Retirement Study (N=5,359, age 65 years or older at baseline) and negative binomial regression models to evaluate if metabolic and inflammatory biomarkers [HbA1c, HDL-cholesterol, C-Reactive Protein (CRP)] mediate the association between specific multimorbidity combinations (at baseline in 2010-2012; grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke) and ADL/IADL disability (at subsequent wave in 2012-2014). Results were adjusted for sociodemographic characteristics, body-mass index, number of coexisting chronic diseases, and baseline ADL/IADL score. HbA1c (IRR=1.01, p=0.004) and CRP (IRR=1.01, p=0.003), but not HDL, were positively associated with the number of coexisting diseases. After adjustment for coexisting diseases, higher HbA1c was associated with greater ADL/IADL limitations for multimorbidity combinations including arthritis (IRR=1.11, p=0.047) and stroke (IRR=1.11, p=0.047), but not for combinations centered around other diseases, while CRP was no longer significantly associated with ADL/IADL limitations for any of the multimorbidity combinations. Models accounting for HbA1c and CRP, respectively, showed that only combinations including cognitive impairment had greater ADL/IADL limitations (IRR=1.45, p=0.015) compared to combinations without cognitive impairment. Insulin resistance and inflammation are strongly associated with the burden of multimorbidity; this strong association, rather than the biomarkers per se, appears to explain the greater ADL/IADL burden observed with all disease-specific multimorbidity combinations, except cognitive impairment.
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Affiliation(s)
| | - Sheila Markwardt
- School of Public Health - Portland State University, Portland, Oregon, United States
| | - Ana Quinones
- Oregon Health & Science University, Portland, Oregon, United States
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Botoseneanu A, Markwardt S, Allore H, Nagel C, Newsom J, Dorr D, Quinones A. Multimorbidity Accumulation by Race or Ethnicity and Body-Weight Status Among Middle-Aged and Older Americans. Innov Aging 2020. [PMCID: PMC7741916 DOI: 10.1093/geroni/igaa057.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in multimorbidity accumulation according to body-mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups. Data from the 1998-2016 Health & Retirement Study (N=8,106, 51-55 years at baseline) and generalized estimating equations models with inverse probability weights estimated the accumulation of seven chronic diseases (arthritis, cancer, diabetes, heart disease, hypertension, lung disease, and stroke) between racial/ethnic groups [Non-Hispanic White (reference; 64.2%), Non-Hispanic Black (21.6%), Hispanic (14.2%)]. Overweight and obesity were more prevalent in Black (82.3%) and Hispanic (78.9%) than White (70.9 %) participants at baseline. Initial burden of morbidity was higher among Black participants [risk ratio (RR) =1.3, p<0.001] but similar among Hispanic compared with White participants; and higher in overweight or greater BMI categories compared with normal BMI (RR=1.07, 1.15, 1.22, p<0.001, for overweight, obese 1, and obese 2/3 BMI, respectively). Disease accumulation did not differ among racial/ethnic groups. Higher BMI was associated with less disease accumulation compared with the normal BMI category (RR=0.99, 0.98, 0.97, all p<0.001, for overweight, obese 1, and obese 2/3 BMI, respectively, per two-year interval). Black participants crossed the threshold of multimorbidity (≥2 diseases) 4-6 years earlier than White and Hispanic participants. There are substantial differences in initial disease burden between Black and White middle-aged/older adults, but not in the accumulation of disease, suggesting the need to intervene prior to entering middle age to reduce disparities in the burden of multimorbidity among vulnerable racial minorities.
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Affiliation(s)
| | - Sheila Markwardt
- School of Public Health - Portland State University, Portland, Oregon, United States
| | | | - Corey Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Jason Newsom
- Portland State University, Portland, Oregon, United States
| | - David Dorr
- Oregon Health & Science University, Portland, Oregon, United States
| | - Ana Quinones
- Oregon Health & Science University, Portland, Oregon, United States
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21
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Hartung DM, Johnston KA, Irwin A, Markwardt S, Bourdette DN. Trends In Coverage For Disease-Modifying Therapies For Multiple Sclerosis In Medicare Part D. Health Aff (Millwood) 2020; 38:303-312. [PMID: 30715973 DOI: 10.1377/hlthaff.2018.05357] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The high cost of multiple sclerosis (MS) disease-modifying therapies can negatively affect access for patients through increased payer restrictions and higher out-of-pocket spending. Our objective was to describe changes in pharmacy benefit coverage and cost-sharing amounts for MS disease-modifying therapies in the Medicare Part D program, using enrollment-weighted Prescription Drug Plan Formulary files for the period 2007-16. Among therapies available throughout the study period, the rate of prior authorization use increased from 61-66 percent of plans to 84-90 percent. The share of plans with at least one therapy available without limitations declined from 39 percent to 17 percent. The projected cumulative out-of-pocket spending for 2019 was $6,894. The therapy with the highest out-of-pocket spending was generic glatiramer acetate. Policy makers need to consider both access restrictions and a growing cost-sharing burden as potential consequences of high and rising drug prices for people with MS.
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Affiliation(s)
- Daniel M Hartung
- Daniel M. Hartung ( ) is an associate professor in the College of Pharmacy, Oregon State University/Oregon Health and Science University, in Portland
| | - Kirbee A Johnston
- Kirbee A. Johnston is a faculty research assistant in the College of Pharmacy, Oregon State University/Oregon Health and Science University
| | - Adriane Irwin
- Adriane Irwin is an assistant professor in the College of Pharmacy, Oregon State University/Oregon Health and Science University
| | - Sheila Markwardt
- Sheila Markwardt is a staff biostatistician in the Biostatistics and Design Program, Oregon Clinical and Translational Research Institute, Oregon Health and Science University
| | - Dennis N Bourdette
- Dennis N. Bourdette is a professor in and chair of the Department of Neurology, Oregon Health and Science University
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Jørgensen TSH, Allore H, Elman MR, Nagel C, Zhang M, Markwardt S, Quiñones AR. Annual Wellness Visits and Influenza Vaccinations among Older Adults in the US. J Prim Care Community Health 2020; 11:2150132720962870. [PMID: 33016194 PMCID: PMC7536477 DOI: 10.1177/2150132720962870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations. METHODS Data on 4999 individuals aged ≥65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations. RESULTS Two-year uptake was 22.8% for AWVs and 65.9% for influenza vaccinations. For AWVs, geographical region and wealth emerged as the most important predictors. For influenza vaccinations, number of somatic conditions, race/ethnicity, education, and wealth were the most important predictors. CONCLUSIONS The importance of geographic region for AWV utilization suggests that this service was unequally adopted. Non-Hispanic black participants and/or those with functional limitations were less likely to receive influenza vaccination.
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Affiliation(s)
| | - Heather Allore
- Yale School of Medicine, New Haven, CT,
USA
- Yale School of Public Health, New Haven,
CT, USA
| | - Miriam R. Elman
- Oregon Health & Science
University/Portland State University, Portland, OR, USA
| | - Corey Nagel
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA
| | | | - Sheila Markwardt
- Oregon Health & Science
University/Portland State University, Portland, OR, USA
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Botoseneanu A, Markwardt S, Allore H, Nagel C, Newsom JT, Dorr DA, Quiñones AR. RACIAL-ETHNIC DIFFERENCES IN MULTIMORBIDITY PROGRESSION ACCORDING TO BODY-WEIGHT STATUS AMONG OLDER U.S. ADULTS. Innov Aging 2019. [PMCID: PMC6840919 DOI: 10.1093/geroni/igz038.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Obesity and multimorbidity are more prevalent among underrepresented U.S. racial/ethnic minority groups. Evaluating whether racial/ethnic disparities in multimorbidity accumulation vary according to body-mass index (BMI) may guide interventions aimed at reducing multimorbidity burden in vulnerable racial/ethnic groups. We used 1998-2014 data from the Health & Retirement Study (N=8,635 participants, age 51-55 years old at baseline) and negative binomial models stratified by BMI category to evaluate differences in rates of accumulation of seven chronic conditions (arthritis, cancer, diabetes, heart disease, hypertension, lung disease, and stroke), focusing on differences between racial/ethnic groups [White (reference; 64.7%), Black (21.5%), Hispanic (13.8%)]. Overweight and obesity were more prevalent in Black (80.9%) and Hispanic (78.6%) than White (69.9%) participants at baseline; in all BMI categories, Black participants had higher rates of multimorbidity compared with White participants (normal BMI:β=0.304, p<0.001; overweight:β=0.243,p<0.001; and obese:β=0.135,p=0.013); initial burden of disease was similar between Whites and Hispanics in the normal and overweight categories, but significantly lower among Hispanics (vs. Whites) in the obese category (β= -0.180,p=0.017). We found no significant differences in rates of disease accumulation between the racial/ethnic groups in any of the BMI categories. There are substantial differences in initial disease burden between Black and White middle-aged/older adults, but not in the rate of accumulation of disease between the race/ethnic groups in the 3 main BMI categories. These findings suggest an opportunity to reduce racial disparities in multimorbidity by intervening early in the lifecourse to reduce the burden of chronic disease among vulnerable racial minorities prior to entering middle-age.
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Affiliation(s)
| | - Sheila Markwardt
- Oregon Health & Science University, Portland, Oregon, United States
| | | | - Corey Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Jason T Newsom
- Portland State University, Portland, Oregon, United States
| | - David A Dorr
- Oregon Health & Science University, Portland, Oregon, United States
| | - Ana R Quiñones
- Family Medicine, Oregon Health & Science University, Portland, Oregon, United States
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24
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Quiñones AR, Botoseneanu A, Markwardt S, Nagel C, Newsom JT, Dorr DA, Allore HG. TRACKING CHANGES IN MULTIMORBIDITY AMONG RACIALLY AND ETHNICALLY DIVERSE POPULATIONS. Innov Aging 2019. [PMCID: PMC6840299 DOI: 10.1093/geroni/igz038.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Multimorbidity is widely recognized as having adverse effects on health and wellbeing above and beyond the risk attributable to individual chronic disease. Much of what is known about multimorbidity rests on research that has largely focused on one point-in-time, or from a static perspective, with little consideration to issues involved in assessing longitudinal changes in multimorbidity. In addition, less focus has been placed on assessing racial and ethnic variations in longitudinal changes of multimorbidity. Addressing this knowledge gap, we highlight important issues and considerations in addressing multimorbidity research from a longitudinal perspective and present findings from longitudinal models that examine differences in the rate of chronic disease accumulation and multimorbidity onset between non-Hispanic white (white), non-Hispanic black (black), and Hispanic study participants in the Health and Retirement Study starting in middle-age and followed for up to 16 years.
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Affiliation(s)
- Ana R Quiñones
- Family Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | | | - Sheila Markwardt
- Oregon Health & Science University, Portland, Oregon, United States
| | - Corey Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Jason T Newsom
- Portland State University, Portland, Oregon, United States
| | - David A Dorr
- Oregon Health & Science University, Portland, Oregon, United States
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25
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Quiñones AR, Botoseneanu A, Markwardt S, Nagel CL, Newsom JT, Dorr DA, Allore HG. Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PLoS One 2019; 14:e0218462. [PMID: 31206556 PMCID: PMC6576751 DOI: 10.1371/journal.pone.0218462] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background Multimorbidity–having two or more coexisting chronic conditions–is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years. Methods and findings We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51–55 years of age at their first interview any time during the study period (1998–2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases. Conclusions Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.
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Affiliation(s)
- Ana R. Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- * E-mail:
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, Michigan, United States of America
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, Oregon, United States of America
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Biostatistics School of Public Health, Yale University, New Haven, Connecticut, United States of America
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26
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Quiñones AR, Markwardt S, Botoseneanu A. Diabetes-Multimorbidity Combinations and Disability Among Middle-aged and Older Adults. J Gen Intern Med 2019; 34:944-951. [PMID: 30815788 PMCID: PMC6544693 DOI: 10.1007/s11606-019-04896-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/17/2018] [Accepted: 01/24/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity). OBJECTIVE To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes. DESIGN A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability. PARTICIPANTS Analytic sample included 3841 HRS participants with diabetes, aged 51 years and older. MAIN MEASURES The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score ≥ 4). KEY RESULTS The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritis-hypertension (n = 694, 18.1%); diabetes-hypertension (n = 481, 12.5%); and diabetes-arthritis-hypertension-heart disease (n = 383, 10%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-to-head comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritis-hypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetes-arthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment. CONCLUSIONS Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.
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Affiliation(s)
- Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA. .,OHSU-PSU School of Public Health, Portland, OR, USA.
| | | | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI, USA.,Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
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Salinsky M, Rutecki P, Parko K, Goy E, Storzbach D, Markwardt S, Binder L, Joos S. Health-related quality of life in Veterans with epileptic and psychogenic nonepileptic seizures. Epilepsy Behav 2019; 94:72-77. [PMID: 30893618 DOI: 10.1016/j.yebeh.2019.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 11/18/2022]
Abstract
RATIONALE Health-related quality of life (HRQoL) is compromised in civilians with epileptic seizures (ES) or psychogenic nonepileptic seizures (PNES). U.S. Veterans are a distinct patient group with regard to gender, age, and background. We studied HRQoL in Veterans and asked the following: (1) Is there a difference in HRQoL in Veterans with ES vs. PNES?; (2) What factors influence HRQoL in each group?; (3) What factors influenced the difference between seizure groups? METHODS We studied consecutive Veterans entering the epilepsy monitoring units (EMUs) of three VA Epilepsy Centers of Excellence. Patients underwent continuous video-EEG monitoring. Seizure diagnoses followed established criteria. Health-related quality of life was measured with the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Evaluations included the Structured Clinical Interview for Diagnostic and Statistical Manual-IV (DSM IV), the posttraumatic stress disorder (PTSD) Checklist (PCL), the Beck Depression Inventory II (BDI-II), and the Minnesota Multiphasic Personality Inventory-2 Restructured form (MMPI-2RF). Between-group differences were tested with Wilcoxon tests. Nested regression analysis was used to evaluate the influence of demographic, social, military, seizure-related, and psychological factors on QOLIE-31 scores. RESULTS The median QOLIE-31 total score was 14 points lower in Veterans with PNES vs. ES (p < 0.001; Cohen's d = 0.73). Within each seizure group, psychological factors accounted for ≥50% of the variance in QOLIE scores while combined demographic, social, and seizure-related factors accounted for 18% (group with ES) and 7% (PNES). Psychological measures, particularly PCL and the BDI-II scores, accounted for all of the difference in QOLIE-31 total scores between Veterans with ES and those with PNES. CONCLUSIONS Health-related quality of life as measured by the QOLIE-31 is worse in Veterans with PNES as compared with those with ES. Psychological factors account for the most of the variance in QOLIE-31 scores regardless of seizure type and also account for the difference between groups with PNES and ES. Demographic, military, social, and seizure-related factors have minimal influence on HRQoL. These results in U.S. Veterans are similar to those found in civilians despite differences in patient age, gender, and background.
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Affiliation(s)
- Martin Salinsky
- VA Portland Health Care System, Portland, OR, United States of America; Oregon Health & Science University, Portland, OR, United States of America.
| | - Paul Rutecki
- William S. Middleton Memorial Veterans Affairs Medical Center, Madison, WI, United States of America
| | - Karen Parko
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
| | - Elizabeth Goy
- VA Portland Health Care System, Portland, OR, United States of America
| | - Daniel Storzbach
- VA Portland Health Care System, Portland, OR, United States of America
| | - Sheila Markwardt
- Oregon Health & Science University, Portland, OR, United States of America
| | - Laurence Binder
- Oregon Health & Science University, Portland, OR, United States of America
| | - Sandra Joos
- VA Portland Health Care System, Portland, OR, United States of America
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28
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Quiñones AR, Markwardt S, Thielke S, Rostant O, Vásquez E, Botoseneanu A. Prospective Disability in Different Combinations of Somatic and Mental Multimorbidity. J Gerontol A Biol Sci Med Sci 2019; 73:204-210. [PMID: 28541396 DOI: 10.1093/gerona/glx100] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background Multimorbidity (multiple co-occurring chronic conditions) may be an important contributor to disability and poor health-related quality of life. The functional consequences of specific combinations of somatic and mental health conditions are unclear. Methods Nationally representative prospective cohort study using the National Health and Aging Trends Study data of Medicare beneficiaries. We included 4,017 participants aged 65 years or older interviewed in 2013 and 2014. The primary outcome was prospective activities of daily living (ADL)-instrumental ADL (IADL) index (range = 0-11) assessed in 2014. All other measures were assessed in 2013. Chronic conditions included heart disease, hypertension, stroke, diabetes, arthritis, lung disease, osteoporosis, cancer, depression, and cognitive impairment. Analyses were adjusted for age, sex, education, race/ethnicity, body mass index, and baseline ADL-IADL. Results Thirty-four percent of multimorbidity combinations included depression, cognitive impairment, or both. Relative to multimorbidity combinations of exclusively somatic conditions, combinations that included both depression and cognitive impairment were associated with 1.34 times greater ADL-IADL in adjusted models (95% confidence interval [CI]: 1.09, 1.64). Relative to combinations of both depression and cognitive impairment, combinations of cognitive impairment and somatic conditions were associated with 0.84 times lower ADL-IADL in adjusted models (95% CI: 0.74, 0.96); combinations of depression and somatic conditions were associated with 0.72 times lower ADL-IADL in adjusted models (95% CI: 0.62, 0.85). Conclusions Depression and/or cognitive impairment was identified in one-third of older adults with multimorbidity, and these combinations were associated with substantially greater prospective disability than combinations comprised exclusively of somatic conditions. This argues for identifying and managing mental health conditions that co-occur with somatic conditions.
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Affiliation(s)
- Ana R Quiñones
- Oregon Health & Science University, OHSU-PSU School of Public Health, Portland
- VA Portland Health Care System, Oregon
| | - Sheila Markwardt
- Oregon Health & Science University, OHSU-PSU School of Public Health, Portland
| | - Stephen Thielke
- VA Puget Sound Health Care System, Geriatric Research, Education, and Clinical Center, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Ola Rostant
- National Institute on Aging, Intramural Research Program, Baltimore, Maryland
| | | | - Anda Botoseneanu
- University of Michigan-Dearborn, Health Policy Studies
- Institute of Gerontology, University of Michigan
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29
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Eller JM, Stewart ML, Slepian AJ, Markwardt S, Wiedrick J, Cohen MS, Goodman RH, Cambronne XA. Flow Cytometry Analysis of Free Intracellular NAD + Using a Targeted Biosensor. ACTA ACUST UNITED AC 2018; 88:e54. [PMID: 30556645 DOI: 10.1002/cpcy.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Flow cytometry approaches combined with a genetically encoded targeted fluorescent biosensor are used to determine the subcellular compartmental availability of the oxidized form of nicotinamide adenine dinucleotide (NAD+ ). The availability of free NAD+ can affect the activities of NAD+ -consuming enzymes such as sirtuin, PARP/ARTD, and cyclic ADPR-hydrolase family members. Many methods for measuring the NAD+ available to these enzymes are limited because they cannot determine free NAD+ as it exists in various subcellular compartments distinctly from bound NAD+ or NADH. Here, an approach to express the sensor in mammalian cells, monitor NAD+ -dependent fluorescence intensity changes using flow cytometry approaches, and analyze data obtained is described. The benefit of flow cytometry approaches with the NAD+ sensor is the ability to monitor compartmentalized free NAD+ fluctuations simultaneously within many cells, which greatly facilitates analyses and calibration. © 2018 by John Wiley & Sons, Inc.
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Affiliation(s)
- Jared M Eller
- Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas
| | - Melissa L Stewart
- Vollum Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Sheila Markwardt
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon
| | - Jack Wiedrick
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon
| | - Michael S Cohen
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, Oregon
| | - Richard H Goodman
- Vollum Institute, Oregon Health & Science University, Portland, Oregon
| | - Xiaolu A Cambronne
- Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas
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30
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Quinones A, Markwardt S, Botoseneanu A. ASSOCIATIONS OF MULTIMORBIDITY COMBINATIONS INCLUDING DIABETES WITH DISABILITY AMONG MIDDLE-AGED & OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Quinones
- Family Medicine, Oregon Health and Sciences University
| | | | - A Botoseneanu
- Health Policy Studies, University of Michigan-Dearborn
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31
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Fiedler SE, Yadav V, Kerns AR, Tsang C, Markwardt S, Kim E, Spain R, Bourdette D, Salinthone S. Lipoic Acid Stimulates cAMP Production in Healthy Control and Secondary Progressive MS Subjects. Mol Neurobiol 2017; 55:6037-6049. [PMID: 29143287 DOI: 10.1007/s12035-017-0813-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 10/27/2017] [Indexed: 02/05/2023]
Abstract
Lipoic acid (LA) exhibits antioxidant and anti-inflammatory properties; supplementation reduces disease severity and T lymphocyte migration into the central nervous system in a murine model of multiple sclerosis (MS), and administration in secondary progressive MS (SPMS) subjects reduces brain atrophy compared to placebo. The mechanism of action (MOA) of LA's efficacy in suppression of MS pathology is incompletely understood. LA stimulates production of the immunomodulator cyclic AMP (cAMP) in vitro. To determine whether cAMP could be involved in the MOA of LA in vivo, we performed a clinical trial to examine whether LA stimulates cAMP production in healthy control and MS subjects, and whether there are differences in the bioavailability of LA between groups. We administered 1200 mg of oral LA to healthy control, relapsing remitting MS (RRMS) and SPMS subjects, and measured plasma LA and cAMP levels in peripheral blood mononuclear cells (PBMCs). There were no significant differences between the groups in pharmacokinetic (PK) parameters. Healthy and SPMS subjects had increased cAMP at 2 and 4 h post-LA treatment compared to baseline, while RRMS subjects showed decreases in cAMP. Additionally, plasma concentrations of prostaglandin E2 (PGE2, a known cAMP stimulator) were significantly lower in female RRMS subjects compared to female HC and SPMS subjects 4 h after LA ingestion. These data indicate that cAMP could be part of the MOA of LA in SPMS, and that there is a divergent response to LA in RRMS subjects that may have implications in the efficacy of immunomodulatory drugs. This clinical trial, "Defining the Anti-inflammatory Role of Lipoic Acid in Multiple Sclerosis," NCT00997438, is registered at https://clinicaltrials.gov/ct2/show/record/NCT00997438 .
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Affiliation(s)
- Sarah E Fiedler
- VA Portland Health Care System, Research and Development Service, Mail Code R&D8, 3710 SW US Veterans' Hospital Rd, Portland, OR, 97239, USA
| | - Vijayshree Yadav
- VA Portland Health Care System, Research and Development Service, Mail Code R&D8, 3710 SW US Veterans' Hospital Rd, Portland, OR, 97239, USA.,Department of Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Amelia R Kerns
- VA Portland Health Care System, Research and Development Service, Mail Code R&D8, 3710 SW US Veterans' Hospital Rd, Portland, OR, 97239, USA
| | - Catherine Tsang
- VA Portland Health Care System, Research and Development Service, Mail Code R&D8, 3710 SW US Veterans' Hospital Rd, Portland, OR, 97239, USA
| | - Sheila Markwardt
- OCTRI Biostatistics and Design Program, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Edward Kim
- VA Portland Health Care System, Research and Development Service, Mail Code R&D8, 3710 SW US Veterans' Hospital Rd, Portland, OR, 97239, USA.,Department of Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Rebecca Spain
- VA Portland Health Care System, Research and Development Service, Mail Code R&D8, 3710 SW US Veterans' Hospital Rd, Portland, OR, 97239, USA.,Department of Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Dennis Bourdette
- VA Portland Health Care System, Research and Development Service, Mail Code R&D8, 3710 SW US Veterans' Hospital Rd, Portland, OR, 97239, USA.,Department of Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Sonemany Salinthone
- VA Portland Health Care System, Research and Development Service, Mail Code R&D8, 3710 SW US Veterans' Hospital Rd, Portland, OR, 97239, USA. .,Department of Neurology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
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Swanson C, Shea SA, Wolfe P, Markwardt S, Cain SW, Munch M, Czeisler CA, Orwoll ES, Buxton OM. 24-hour profile of serum sclerostin and its association with bone biomarkers in men. Osteoporos Int 2017; 28:3205-3213. [PMID: 28744601 PMCID: PMC5859541 DOI: 10.1007/s00198-017-4162-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/12/2017] [Indexed: 12/20/2022]
Abstract
UNLABELLED The osteocyte's role in orchestrating diurnal variations in bone turnover markers (BTMs) is unclear. We identified no rhythm in serum sclerostin (osteocyte protein). These results suggest that serum sclerostin can be measured at any time of day and the osteocyte does not direct the rhythmicity of other BTMs in men. INTRODUCTION The osteocyte exerts important effects on bone remodeling, but its rhythmicity and effect on the rhythms of other bone cells are not fully characterized. The purpose of this study was to determine if serum sclerostin displays rhythmicity over a 24-h interval, similar to that of other bone biomarkers. METHODS Serum sclerostin, FGF-23, CTX, and P1NP were measured every 2 h over a 24-h interval in ten healthy men aged 20-65 years. Maximum likelihood estimates of the parameters in a repeated measures model were used to determine if these biomarkers displayed a diurnal, sinusoidal rhythm. RESULTS No discernible 24-h rhythm was identified for sclerostin (p = 0.99) or P1NP (p = 0.65). CTX rhythmicity was confirmed (p < 0.001), peaking at 05:30 (range 01:30-07:30). FGF-23 levels were also rhythmic (p < 0.001), but time of peak was variable (range 02:30-11:30). The only significant association identified between these four bone biomarkers was for CTX and P1NP mean 24-h metabolite levels (r = 0.65, p = 0.04). CONCLUSIONS Sclerostin levels do not appear to be rhythmic in men. This suggests that in contrast to CTX, serum sclerostin could be measured at any time of day. The 24-h profiles of FGF-23 suggest that a component of osteocyte function is rhythmic, but its timing is variable. Our results do not support the hypothesis that osteocytes direct the rhythmicity of other bone turnover markers (CTX), at least not via a sclerostin-mediated mechanism.
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Affiliation(s)
- C Swanson
- Division of Endocrinology and Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA.
- Division of Endocrinology, University of Colorado, 12801 E. 17th Ave. Mail Stop 8106, Aurora, CO, 80045, USA.
| | - S A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - P Wolfe
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S Markwardt
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - S W Cain
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, VIC, 3800, Australia
| | - M Munch
- Charité University Medicine Berlin, Institute of Physiology, Berlin, Germany
| | - C A Czeisler
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - E S Orwoll
- Division of Endocrinology and Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - O M Buxton
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, MA, USA
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Quinones A, Botoseneanu A, Markwardt S, Allore H. RACIAL-ETHNIC DIFFERENCES IN MULTIMORBIDITY COMBINATIONS OVER TIME. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A.R. Quinones
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon,
| | | | - S. Markwardt
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon,
| | - H. Allore
- Yale University, New Haven, Connecticut
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Boone-Heinonen J, Markwardt S, Fortmann SP, Thornburg KL. Overcoming birth weight: can physical activity mitigate birth weight-related differences in adiposity? Pediatr Obes 2016; 11:166-73. [PMID: 25988588 PMCID: PMC4653090 DOI: 10.1111/ijpo.12040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Individuals born at low or high birth weight (BW) have elevated adiposity. The extent to which physical activity can mitigate this risk is unknown. OBJECTIVES The aim of this study was to determine if associations between BW and adiposity vary by self-reported moderate-to-vigorous physical activity (MVPA) among adolescents. METHODS We used data on adolescents in the National Health and Nutrition Examination Survey (1999-2006; 12-15 years; n = 4064). Using gender-stratified linear regression, we modelled body mass index (BMI) and waist circumference (WC) z-scores as a function of low, normal and high BW, MVPA (weekly Metabolic Equivalent of Task hours) and MVPA*BW cross-product terms, adjusting for sociodemographics, diet and, in WC models, BMI. RESULTS Among girls with low MVPA, those born with high BW had greater BMI than normal BW; this difference diminished with greater MVPA (coefficient [95% confidence interval]: low MVPA: 0.72 [0.29, 1.14]; high MVPA: -0.04 [-0.48, 0.39]; P for interaction = 0.05). Among boys, MVPA did not modify the associations between BW and BMI. WC was unrelated to BW, regardless of MVPA. CONCLUSIONS Findings suggest that effects of high BW in total adiposity can be more easily modified with MVPA in adolescent girls than in boys.
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Affiliation(s)
- Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University; Portland, OR, USA
| | - Sheila Markwardt
- Department of Public Health and Preventive Medicine, Oregon Health & Science University; Portland, OR, USA
| | | | - Kent L. Thornburg
- Bob and Charlee Moore Institute for Nutrition and Wellness, Oregon Health & Science University; Portland, OR, USA
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Quiñones AR, Markwardt S, Botoseneanu A. Multimorbidity Combinations and Disability in Older Adults. J Gerontol A Biol Sci Med Sci 2016; 71:823-30. [PMID: 26968451 DOI: 10.1093/gerona/glw035] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/11/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Multimorbidity (multiple co-occurring chronic diseases) is associated with greater likelihood of disability and mortality, above and beyond the risk attributable to individual diseases. This study identifies prevalent multimorbidity patterns and evaluates their association with disability among U.S. older adults. METHODS Prospective cohort study using longitudinal Health and Retirement Study data (2010-2012). We included 8,782 participants aged 65 years and older and used negative binomial models to examine prospective disability, measured by the combined activities of daily living-instrumental activities of daily living index. Multimorbidity was defined as the co-occurring combination of at least two of the following chronic diseases: hypertension, cardiovascular disease, lung disease, diabetes, cancer, arthritis, stroke, cognitive impairment, or high depressive symptoms (CES-D score ≥ 4). RESULTS We found 291 unique disease combinations with 1 to 1,167 older adults per disease combination. The three most prevalent combinations were: (a) hypertension and arthritis (n = 1,167); (b) hypertension, arthritis, and cardiovascular disease (n = 510); and (c) hypertension, arthritis, and diabetes (n = 430). Only one of the prevalent combinations included depressive symptoms (in combination with arthritis, hypertension; n = 129). This group showed the highest level of activities of daily living-instrumental activities of daily living disability compared to healthy participants or participants with a single disease (either included in the combination or different from diseases in the combination) even after adjusting for age, gender, education, race/ethnicity, and body mass index. CONCLUSIONS Clinicians stand to gain from a better understanding of which disease combinations are more and less disabling among older adults. Understanding how multimorbidity combinations relate to functional status is an important step towards reducing disability and sustaining independent living among older adults.
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Affiliation(s)
- Ana R Quiñones
- School of Public Health, Oregon Health & Science University, Portland. Portland VA Medical Center, Oregon.
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland
| | - Anda Botoseneanu
- Department of Behavioral Sciences, Health Policy Studies, University of Michigan-Dearborn . Institute of Gerontology, University of Michigan, Ann Arbor
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Hartung DM, Middleton L, Markwardt S, Williamson K, Ketchum K. Changes in long-acting β-agonist utilization after the FDA's 2010 drug safety communication. Clin Ther 2014; 37:114-123.e1. [PMID: 25465946 DOI: 10.1016/j.clinthera.2014.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/24/2014] [Accepted: 10/28/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE In February 2010, the US Food and Drug Administration (FDA) issued new recommendations for the safe use of long-acting β-agonists (LABAs) in patients with asthma. The objective of this study was to determine the impact of the FDA's 2010 safety advisory on LABA utilization. METHODS Using administrative data from the Oregon Medicaid program, we performed an interrupted time series regression to evaluate changes in the trend in new LABA prescriptions before and after the FDA's 2010 advisory. Trends in incident fills were examined among those with and without an asthma diagnosis code and previous respiratory controller medication use; trends were also assessed according to patient age. FINDINGS The average age of the 8646 study patients was 37 years, 53% had a diagnosis of asthma, 21% had no respiratory diagnosis, and 32% had not used a respiratory controller medication in the recent past. The trend in new LABA prescriptions declined by 0.09 new start per 10,000 patients per month (95% CI, -0.19 to -0.01) after the FDA's advisory. Among those with a diagnosis of asthma, there was an immediate drop of 0.48 (95% CI, -0.93 to -0.03) and a 0.10 (95% CI, -0.13 to -0.06) decline in the monthly rate of new starts per 10,000 patients. Immediately after the FDA's advisory, we observed a statistically significant 4.7% increase (95% CI, 0.8 to 8.7) in the proportion of new LABA starts with history of previous respiratory controller medication use. Utilization of LABAs did not change in those without a diagnosis of asthma. IMPLICATIONS The FDA's 2010 advisory was associated with modest reductions in LABA utilization overall and in ways highlighted in their recommendations.
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Affiliation(s)
- Daniel M Hartung
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, Oregon.
| | - Luke Middleton
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, Oregon
| | - Sheila Markwardt
- Oregon Health & Science University, Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Kaylee Williamson
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, Oregon
| | - Kathy Ketchum
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, Oregon
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Lee DSH, Markwardt S, Goeres L, Lee CG, Eckstrom E, Williams C, Fu R, Orwoll E, Cawthon PM, Stefanick ML, Mackey D, Bauer DC, Nielson CM. Statins and physical activity in older men: the osteoporotic fractures in men study. JAMA Intern Med 2014; 174:1263-70. [PMID: 24911216 PMCID: PMC4346343 DOI: 10.1001/jamainternmed.2014.2266] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Muscle pain, fatigue, and weakness are common adverse effects of statin medications and may decrease physical activity in older men. OBJECTIVE To determine whether statin use is associated with physical activity, longitudinally and cross-sectionally. DESIGN, SETTING, AND PARTICIPANTS Men participating in the Osteoporotic Fractures in Men Study (N = 5994), a multicenter prospective cohort study of community-living men 65 years and older, enrolled between March 2000 and April 2002. Follow-up was conducted through 2009. EXPOSURES Statin use as determined by an inventory of medications (taken within the last 30 days). In cross-sectional analyses (n = 4137), statin use categories were users and nonusers. In longitudinal analyses (n = 3039), categories were prevalent users (baseline use and throughout the study), new users (initiated use during the study), and nonusers (never used). MAIN OUTCOMES AND MEASURES Self-reported physical activity at baseline and 2 follow-up visits using the Physical Activity Scale for the Elderly (PASE). At the third visit, an accelerometer measured metabolic equivalents (METs [kilocalories per kilogram per hour]) and minutes of moderate activity (METs ≥3.0), vigorous activity (METs ≥6.0), and sedentary behavior (METs ≤1.5). RESULTS At baseline, 989 men (24%) were users and 3148 (76%) were nonusers. The adjusted difference in baseline PASE between users and nonusers was -5.8 points (95% CI, -10.9 to -0.7 points). A total of 3039 men met the inclusion criteria for longitudinal analysis: 727 (24%) prevalent users, 845 (28%) new users, and 1467 (48%) nonusers. PASE score declined by a mean (95% CI) of 2.5 (2.0 to 3.0) points per year for nonusers and 2.8 (2.1 to 3.5) points per year for prevalent users, a nonstatistical difference (0.3 [-0.5 to 1.0] points). For new users, annual PASE score declined at a faster rate than nonusers (difference of 0.9 [95% CI, 0.1 to 1.7] points). A total of 3071 men had adequate accelerometry data, 1542 (50%) were statin users. Statin users expended less METs (0.03 [95% CI, 0.02-0.04] METs less) and engaged in less moderate physical activity (5.4 [95% CI, 1.9-8.8] fewer minutes per day), less vigorous activity (0.6 [95% CI, 0.1-1.1] fewer minutes per day), and more sedentary behavior (7.6 [95% CI, 2.6-12.4] greater minutes per day). CONCLUSIONS AND RELEVANCE Statin use was associated with modestly lower physical activity among community-living men, even after accounting for medical history and other potentially confounding factors. The clinical significance of these findings deserves further investigation.
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Affiliation(s)
- David S H Lee
- Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland
| | - Sheila Markwardt
- Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland
| | - Leah Goeres
- Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland
| | - Christine G Lee
- Research Service, Department of Veterans Affairs Medical Center, Portland, Oregon3Division of Endocrinology, Department of Medicine, Diabetes and Clinical Nutrition, Oregon Health and Science University School of Medicine, Portland
| | - Elizabeth Eckstrom
- Division of General Medicine and Geriatrics, Oregon Health and Science University School of Medicine, Portland
| | - Craig Williams
- Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland
| | - Rongwei Fu
- Department of Public Health and Preventive Medicine, Oregon Health and Science University School of Medicine, Portland
| | - Eric Orwoll
- Division of Endocrinology, Department of Medicine, Diabetes and Clinical Nutrition, Oregon Health and Science University School of Medicine, Portland
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco
| | - Marcia L Stefanick
- Prevention Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
| | - Dawn Mackey
- California Pacific Medical Center Research Institute, San Francisco
| | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco
| | - Carrie M Nielson
- Department of Public Health and Preventive Medicine, Oregon Health and Science University School of Medicine, Portland
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Lee DS, Markwardt S, McAvay GJ, Gross CP, Goeres LM, Han L, Peduzzi P, Lin H, Dodson JA, Tinetti ME. Effect of β-blockers on cardiac and pulmonary events and death in older adults with cardiovascular disease and chronic obstructive pulmonary disease. Med Care 2014; 52 Suppl 3:S45-51. [PMID: 24561758 PMCID: PMC4050644 DOI: 10.1097/mlr.0000000000000035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT In older adults with multiple conditions, medications may not impart the same benefits seen in patients who are younger or without multimorbidity. Furthermore, medications given for one condition may adversely affect other outcomes. β-Blocker use with coexisting cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) is such a situation. OBJECTIVE To determine the effect of β-blocker use on cardiac and pulmonary outcomes and mortality in older adults with coexisting COPD and CVD. DESIGN, SETTING, PARTICIPANTS The study included 1062 participants who were members of the 2004-2007 Medicare Current Beneficiary Survey cohorts, a nationally representative sample of Medicare beneficiaries. Study criteria included age over 65 years plus coexisting CVD and COPD/asthma. Follow-up occurred through 2009. We determined the association between β-blocker use and the outcomes with propensity score-adjusted and covariate-adjusted Cox proportional hazards. MAIN OUTCOME MEASURES The 3 outcomes were major cardiac events, pulmonary events, and all-cause mortality. RESULTS Half of the participants used β-blockers. During follow-up, 179 participants experienced a major cardiac event; 389 participants experienced a major pulmonary event; and 255 participants died. Each participant could have experienced any ≥1 of these events. The hazard ratio for β-blocker use was 1.18 [95% confidence interval (CI), 0.85-1.62] for cardiac events, 0.91 (95% CI, 0.73-1.12) for pulmonary events, and 0.87 (95% CI, 0.67-1.13) for death. CONCLUSION In this population of older adults, β-blockers did not seem to affect occurrence of cardiac or pulmonary events or death in those with CVD and COPD.
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Affiliation(s)
- David S.H. Lee
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR
| | - Sheila Markwardt
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR
| | | | | | - Leah M. Goeres
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR
| | - Ling Han
- Department of Medicine, Yale School of Medicine
| | | | - Haiqun Lin
- Yale School of Public Health, New Haven, CT
| | | | - Mary E. Tinetti
- Department of Medicine, Yale School of Medicine
- Yale School of Public Health, New Haven, CT
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Wu YJ, Muldoon LL, Varallyay C, Markwardt S, Jones RE, Neuwelt EA. In vivo leukocyte labeling with intravenous ferumoxides/protamine sulfate complex and in vitro characterization for cellular magnetic resonance imaging. Am J Physiol Cell Physiol 2007; 293:C1698-708. [PMID: 17898131 DOI: 10.1152/ajpcell.00215.2007] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cellular labeling with ferumoxides (Feridex IV) superparamagnetic iron oxide nanoparticles can be used to monitor cells in vivo by MRI. The objective of this study was to use histology and MRI to evaluate an in vivo, as opposed to in vitro, technique for labeling of mononuclear leukocytes as a means of tracking inflammatory processes in the brain. Long-Evans rats were intravenously injected with 20 mg/kg ferumoxides, ferumoxtran-10, or ferumoxytol with or without protamine sulfate. Leukocytes and splenocytes were evaluated by cell sorting and iron histochemistry or were implanted into the brain for MRI. Injection of ferumoxides/protamine sulfate complex IV resulted in iron labeling of leukocytes (ranging from 7.4 ± 0.5% to 12.5 ± 0.9% with average 9.2 ± 0.8%) compared with ferumoxides (ranging from 3.9 ± 0.4% to 6.3 ± 0.5% with average 5.0 ± 0.5%) or protamine sulfate alone (ranging from 0% to 0.9 ± 0.7% with average 0.3 ± 0.3%). Cell sorting analysis indicated that iron-labeled cells were enriched for cell types positive for the myelomonocytic marker (CD11b/c) and the B lymphocyte marker (CD45RA) and depleted in the T cell marker (CD3). Neither ferumoxtran-10 nor ferumoxytol with protamine sulfate labeled leukocytes. In vivo ferumoxides/protamine sulfate-loaded leukocytes and splenocytes were detected by MRI after intracerebral injection. Ferumoxides/protamine complex labeled CD45RA-positive and CD11b/c-positive leukocytes in vivo without immediate toxicity. The dose of feumoxides in this report is much higher than the approved human dose, so additional animal studies are required before this approach could be translated to the clinic. These results might provide useful information for monitoring leukocyte trafficking into the brain.
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Affiliation(s)
- Y Jeffrey Wu
- Research Service, Veterans Administration Medical Center, Oregon Health and Sciences University, Portland, Oregon 97239, USA
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